Healthcare Provider Details

I. General information

NPI: 1295258507
Provider Name (Legal Business Name): COURTNEY ELIZABETH DEAN DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 8TH AVE NE
HAZEN ND
58545-4637
US

IV. Provider business mailing address

1312 HIGHWAY 49 N
BEULAH ND
58523-6038
US

V. Phone/Fax

Practice location:
  • Phone: 701-748-2256
  • Fax:
Mailing address:
  • Phone: 701-873-4445
  • Fax: 701-873-4199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR41769
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: